Date of Report * Date Reported to the CSA Year Year20152016201720182019 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Name of Campus Security Authority * Name of the Campus Security Authority Reporting the Crime Date of Incident * Year Year20152016201720182019 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Reported by * Who Reported to the CSA? The Victim A Third Party Other Victim Name Victim Name (Optional) Victim Phone Number Victim Phone Number - Optional Victim Email Address Victim Email Address - Optional Agency Notified * To your knowledge, was a law enforcement agency notified of this crime? Yes No Name of Agency Name of Agency Other Departments Were Other Departments Contacted? OSMRC Dean of Students Housing No Internal Tracking Number If you have an internal tracking number, you can enter it here. Law Enforcement to Contact Victim? * Does the victim want the incident reported to law enforcement? Yes No Location of Incident * Location of the Incident Time of Incident Time of Incident (Approximately) Hour Hour01234567891011121314151617181920212223 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Incident Description * Please describe the incident. Classification * Part I Crime - Please indicate the incident category to the best of your ability. Homicide Rape Fondling Robbery Aggravated Assault Burglary Arson Motor Vehicle Theft Not Sure Liquor/Drug/Weapon Was this a Liquor, Drug, or Weapon Arrest or Referral? Liquor Law Arrest Drug Law Arrest Weapon Law Arrest Liquor Law Referral Drug Law Referral Weapon Law Referral VAWA Was this a VAWA Crime? Dating Violence Domestic Violence Stalking Bias * Yes No Is there any evidence this crime was motivated by bias? Bias Type? If there was bias, please choose any/all categories of prejudice that apply: Race Gender Gender Identity Ethnicity Religion Disability National Origin Sexual Orientation Bias Description If you answered yes to the bias, please provide a brief summary of the reasoning for the bias motivation.